Monday, April 11, 2005

Conscience versus professional duties.

There has been a fair bit of media coverage lately of conscience clauses for physicians and, more recently, pharmacists. The idea of such clauses is that one ought not to be forced, as part of one's professional duties, to participate in an act one objects to on moral grounds. In other words, under a conscience clause, a physician with a moral objection would not have to perform abortions. A pharmacist who had a moral objection to contraception would not have to fill prescriptions for contraceptives. A nurse who has a moral objection to choosing not to prolong life by any available medical means could ignore a Do-Not-Resuscitate order that a patient has entered herself.

The recent generation of conscience clauses go even further. They allow health care professionals to refuse to refer patients to professionals who might offer the services the patients are seeking.

Obviously, we've got a tug-of-war here between the moral convictions of the health care professionals and the moral convictions of the patients.

One claim that has been made in support of these conscience clauses is that patients can always find someone willing to provide a legal procedure or prescription. There is some question, though, of how easily they can find that someone, how far they will have to travel, how long the wait will be, and what it will cost. Is it ethically permissible that health care professionals withhold knowledge as well as service?

It may be that a more profound holding back of knowledge is happening at the level of education of new health care professionals. The word is that fewer and fewer medical students have access to training in controversial procedures (like abortions) -- whether or not the students themselves have any moral objections to these procedures.

A few big ethical issues are tangled together here. One is what the relationship between health care professional and patient/client ought to be. Does the doctor or pharmacist have a responsibility for the well-being of the patient/client? Is this responsibility for the medical well-being, or the moral well-being as well? What duties does the health care professional have to respect the moral values of the patient/client seeking care?

Is it unjustifiably paternalistic for the health care professional not only to withhold service but also to withhold information? (Wouldn't it be more ethical to provide information on how to locate other providers, even if these information was accompanied by an explanation of the first health care professional's objection?)

Is this a case where specialized knowledge and training really do bring with them a duty towards the people who depend on the services that can only be provided by those with such knowledge and training?

Are certain moral views fundamentally incompatible with becoming an ethical health care professional? (I'm not just thinking of extreme cases -- hedonistic cannibals ought not become surgeons. Should Christian Scientists become pharmacists? Should Jehovah's Witnesses become phlebotomists? Should people utterly opposed to abortion and contraception of any kind, under any circumstances, become OB/GYNs?)

It might be interesting to see what the professional codes of ethics for various health care professions say about these issues. (The exercise is left for the reader ...)


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